Combined Use of Thoracoscopy and Laparoscopy in Total Laryngectomy for Cervical Esophageal Carcinoma

目的探讨胸、腹腔镜联合全喉切除治疗颈段食管的可行性和疗效。方法 2009年1月~2014年7月胸、腹腔镜联合全喉切除治疗33例颈段食管癌。胸腔镜下分离食管、腹腔镜下管胃成形、全喉切除、气管永久造口、胃咽吻合术。结果胸部手术时间40~66 MIn,平均53 MIn;腹部手术时间35~51 MIn,平均44 MIn;颈部手术时间128~150 MIn,平均139 MIn。术中出血量130~270 Ml,平均150 Ml。术后住院时间8~14 d,平均12 d。病理均为鳞状细胞癌,其中高分化2例,中分化19例,中-低分化7例,低分化5例。切缘病理学检查无癌组织残留。31例淋巴结转移。并发症:吻合口漏2例,喉返神经损伤3例,肺部感染6例,胃排空障碍2例,吻合口狭窄1例,无死亡病例。33例随访1个月~5年,术后1、3、5年生存率分别为87.9%、54.5%、45.5%。结论颈段食管癌应采取积极的手术治疗,胃咽吻合术是颈段食管癌切除后较为理想的修复手段。Objective To investigate clinical feasibility and efficacy of combined use of thoracoscopy and laparoscopy in total laryngectomy for cervical esophageal carcinoma.Methods Clinical data of 33 patients with cervical esophageal carcinoma undergoing surgical treatment in our department from January 2009 to July 2014 were analyzed retrospectively.The esophagus was separated under thoracoscopy.And laparoscopic gastroplasty,total laryngectomy,tracheal permanent colostomy,and gastric pharyngeal anastomosis were performed.Results The thoracoscopic operation time was 40- 66 min( mean,53 min),the laparoscopic operation time was 35- 51 min( mean,44 min),and the cervical operation time was 128- 150 min( mean,139 min).The blood loss was 130- 270 ml( mean,150 ml).The postoperative hospital stay was 8- 14 d( mean,12 d).Pathological examinations showed squamous cell carcinoma in all the cases,including 2 cases of highly differentiated carcinoma,19 cases of moderately differentiated carcinoma,7 cases of moderately or lowly differentiated carcinoma,and 5 cases of lowly differentiated carcinoma.No residual cancer was found at cutting edges pathologically.Among the 33 cases,lymph node metastasis was found in 31 cases.Complications included 2 cases of anastomotic fistula,3 cases of recurrent laryngeal nerve injury,6 cases of pulmonary infection,2cases of delayed gastric emptying,and 1 case of anastomotic stenosis.There was no death.All the patients were followed up for 1months to 5 years.The survival rates at 1,3,and 5 postoperative year were 87.9%,54.5%,and 45.5%,respectively.Conclusions Cervical esophageal carcinoma should be surgically treated actively.Gastric pharyngeal anastomosis is an ideal option for the repair of cervical esophageal cancer resection

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